Difference between revisions of "Thyroid"

From patholines.org
Jump to navigation Jump to search
(Split cytology)
(Linked)
(2 intermediate revisions by the same user not shown)
Line 1: Line 1:
{{Top
+
<noinclude>{{Top
 
|author1=[[User:Mikael Häggström|Mikael Häggström]]
 
|author1=[[User:Mikael Häggström|Mikael Häggström]]
 
|author2=
 
|author2=
Line 6: Line 6:
 
*'''[[Hyperthyroidism]]'''
 
*'''[[Hyperthyroidism]]'''
 
*'''[[Thyroid cytology]]'''
 
*'''[[Thyroid cytology]]'''
 
+
</noinclude>
 
{{Fixation - standard}} Fix all thyroids at least overnight to avoid artifactual nuclear atypia.<ref name=chicago2>{{cite web|url=https://voices.uchicago.edu/grosspathology/head-neck/thyroid/#primary-column|title=Gross Pathology Manual By The University of Chicago Department of Pathology}} Updated 2-14-19 NAC.</ref>
 
{{Fixation - standard}} Fix all thyroids at least overnight to avoid artifactual nuclear atypia.<ref name=chicago2>{{cite web|url=https://voices.uchicago.edu/grosspathology/head-neck/thyroid/#primary-column|title=Gross Pathology Manual By The University of Chicago Department of Pathology}} Updated 2-14-19 NAC.</ref>
 
{{Fixation - general notes}}
 
{{Fixation - general notes}}
Line 39: Line 39:
 
File:Causes of hyperthyroidism.png|Most common causes of hyperthyroidism by age.<ref>{{cite journal|last1=Carlé|first1=Allan|last2=Pedersen|first2=Inge Bülow|last3=Knudsen|first3=Nils|last4=Perrild|first4=Hans|last5=Ovesen|first5=Lars|last6=Rasmussen|first6=Lone Banke|last7=Laurberg|first7=Peter|title=Epidemiology of subtypes of hyperthyroidism in Denmark: a population-based study|journal=European Journal of Endocrinology|volume=164|issue=5|year=2011|pages=801–809|issn=0804-4643|doi=10.1530/EJE-10-1155|pmid=21357288}}</ref>
 
File:Causes of hyperthyroidism.png|Most common causes of hyperthyroidism by age.<ref>{{cite journal|last1=Carlé|first1=Allan|last2=Pedersen|first2=Inge Bülow|last3=Knudsen|first3=Nils|last4=Perrild|first4=Hans|last5=Ovesen|first5=Lars|last6=Rasmussen|first6=Lone Banke|last7=Laurberg|first7=Peter|title=Epidemiology of subtypes of hyperthyroidism in Denmark: a population-based study|journal=European Journal of Endocrinology|volume=164|issue=5|year=2011|pages=801–809|issn=0804-4643|doi=10.1530/EJE-10-1155|pmid=21357288}}</ref>
 
File:Histopathology of nodular hyperplasia of the thyroid.png|'''Nodular hyperplasia''': Variable sized dilated follicles with flattened to hyperplastic epithelium, and without any significant capsule. Architecture resembles normal thyroid, but may be somewhat hypercellular.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidnodular.html|title=Thyroid & parathyroid - Hyperplasia / goiter - Multinodular goiter|author=Swati Satturwar, M.D., F. Zahra Aly, M.D., Ph.D.|website=PathologyOutlines}} Last author update: 11 June 2021. Last staff update: 18 November 2021</ref>
 
File:Histopathology of nodular hyperplasia of the thyroid.png|'''Nodular hyperplasia''': Variable sized dilated follicles with flattened to hyperplastic epithelium, and without any significant capsule. Architecture resembles normal thyroid, but may be somewhat hypercellular.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidnodular.html|title=Thyroid & parathyroid - Hyperplasia / goiter - Multinodular goiter|author=Swati Satturwar, M.D., F. Zahra Aly, M.D., Ph.D.|website=PathologyOutlines}} Last author update: 11 June 2021. Last staff update: 18 November 2021</ref>
 +
File:Histopathology of hyperfunctioning and non-hyperfunctioning thyroid follicular adenoma.jpg|'''Thyroid follicular adenoma''', being architecturally and cytologically different from surrounding gland, and being completely enveloped by thin fibrous capsule (if not being encapsulated, mainly consider thyroid carcinoma if atypical cells, otherwise nodular hyperplasia with dominant nodule, the latter especially if there are hyperplastic changes elsewhere in gland).<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidfollicularadenoma.html|title=Thyroid & parathyroid Benign thyroid neoplasms. Follicular adenoma.|author=Sheren Younes, M.D.|website=Pathology Outlines}} Last author update: 1 November 2014. Last staff update: 8 March 2022</ref> Hyperfunctioning follicular adenoma typically shows follicles with papillary infoldings and bubbly, pale colloid with peripheral scalloping (a). Non-hyperfunctioning adenomas with papillary hyperplasia usually show a more predominantly papillary pattern without vacuolated cytoplasm and scalloping colloid (b).<ref name=Cameselle-Teijeiro2020>{{cite journal| author=Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M| title=Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers. | journal=Endocr Pathol | year= 2020 | volume= 31 | issue= 3 | pages= 197-217 | pmid=32632840 | doi=10.1007/s12022-020-09638-x | pmc=7395918 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32632840  }}<br>"This article is licensed under a Creative Commons Attribution 4.0 International License"</ref>
 
File:Histopathology of a Hürthle cell adenoma.jpg|thumb|'''Hürthle cell adenoma''', typically consisting of cells with large size, distinct cell borders, deeply eosinophilic and granular cytoplasm, large nucleus with prominent nucleolus, and complete loss of cell polarity.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidhurthle.html|website=Pathology Outlines|author=Shuanzeng (Sam) Wei, M.D., Ph.D.|title=Thyroid & parathyroid - Other thyroid carcinoma - Main- Oncocytic (Hürthle cell) tumors}} Last author update: 1 October 2017. Last staff update: 21 July 2021</ref>
 
File:Histopathology of a Hürthle cell adenoma.jpg|thumb|'''Hürthle cell adenoma''', typically consisting of cells with large size, distinct cell borders, deeply eosinophilic and granular cytoplasm, large nucleus with prominent nucleolus, and complete loss of cell polarity.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidhurthle.html|website=Pathology Outlines|author=Shuanzeng (Sam) Wei, M.D., Ph.D.|title=Thyroid & parathyroid - Other thyroid carcinoma - Main- Oncocytic (Hürthle cell) tumors}} Last author update: 1 October 2017. Last staff update: 21 July 2021</ref>
File:Histopathology of hyperfunctioning and non-hyperfunctioning thyroid follicular adenoma.jpg|'''Thyroid follicular adenoma''', being architecturally and cytologically different from surrounding gland, and being completely enveloped by thin fibrous capsule (if not being encapsulated, mainly consider thyroid carcinoma if atypical cells, otherwise nodular hyperplasia with dominant nodule, the latter especially if there are hyperplastic changes elsewhere in gland).<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidfollicularadenoma.html|title=Thyroid & parathyroid Benign thyroid neoplasms. Follicular adenoma.|author=Sheren Younes, M.D.|website=Pathology Outlines}} Last author update: 1 November 2014. Last staff update: 8 March 2022</ref> Hyperfunctioning follicular adenoma typically shows follicles with papillary infoldings and bubbly, pale colloid with peripheral scalloping (a). Non-hyperfunctioning adenomas with papillary hyperplasia usually show a more predominantly papillary pattern without vacuolated cytoplasm and scalloping colloid (b).<ref name=Cameselle-Teijeiro2020>{{cite journal| author=Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M| title=Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers. | journal=Endocr Pathol | year= 2020 | volume= 31 | issue= 3 | pages= 197-217 | pmid=32632840 | doi=10.1007/s12022-020-09638-x | pmc=7395918 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32632840  }}<br>"This article is licensed under a Creative Commons Attribution 4.0 International License"</ref>
 
 
File:Pie chart of relative incidences of thyroid cancers.png|Relative incidences of '''malignant''' thyroid tumors.
 
File:Pie chart of relative incidences of thyroid cancers.png|Relative incidences of '''malignant''' thyroid tumors.
 
</gallery>
 
</gallery>
 
===Papillary thyroid carcinoma===
 
===Papillary thyroid carcinoma===
A '''papillary thyroid carcinoma''' is characterized by:
+
A '''[[papillary thyroid carcinoma]]''' is characterized by:
 
<gallery mode=packed heights=200px>
 
<gallery mode=packed heights=200px>
 
File:Histopathology of papillary thyroid cancer in a thyroglossal cyst, high magnification, annotated.jpg|'''Pseudonuclear inclusions''' (representing cytoplasmic invaginations)
 
File:Histopathology of papillary thyroid cancer in a thyroglossal cyst, high magnification, annotated.jpg|'''Pseudonuclear inclusions''' (representing cytoplasmic invaginations)

Revision as of 13:47, 28 November 2022

Author: Mikael Häggström [note 1]

Presentations

Fixation

Generally 10% neutral buffered formalin. Fix all thyroids at least overnight to avoid artifactual nuclear atypia.[1]

  See also: General notes on fixation


Removal during autopsy

Parathyroid glands (white arrow), next to the thyroid gland.

Sharply dissect the thyroid from the cartilage, starting at the posterior end of each lobe & working forward. Do not cut the isthmus. Try to find parathyroids.

Gross processing of thyroidectomy

  • Weigh.[2] Up to 30 g versus over 30 g grams is an accepted cutoff between normal and increased weight of the thyroid gland.[3]
  • Measure each lobe and isthmus in 3 dimensions, respectively.[2]
  • Ink outer surface,[2] at least if malignancy is suspected.[4]

((In addition, use different ink colors on the anterior versus posterior “capsular” or "peripheral" surface.))

Serially section the specimen at 3-4mm intervals,[5] such as follows:[2]

  See also: General notes on gross processing


Microscopic examination

Look primarily for the most commons causes of the presentation at hand, such as hyperthyroidism. Otherwise, thyroid nodules can broadly be classified into benign versus malignant, where the risk of malignancy per nodule case is higher in younger people (approximately 23% in people aged 20-30 and approximately 13% in those aged >70 y).[6] Benign thyroid nodules are generally either follicular adenoma or Hürthle cell adenoma (approximately 60% and 40% of benign nodules, respectively).[7]

Papillary thyroid carcinoma

A papillary thyroid carcinoma is characterized by:

Also, it typically has nuclei with:[13]

  • Enlargement, elongation, overlapping
  • Chromatin with clearing, margination, glassy / ground glass texture
  • Nuclear membrane with irregular contour

Other thyroid tumors

Reporting

For cancers, generally include a synoptic report, such as per College of American Pathologists (CAP) protocols at cap.org/protocols-and-guidelines.

  See also: General notes on reporting


See also

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. . Gross Pathology Manual By The University of Chicago Department of Pathology. Updated 2-14-19 NAC.
  2. 2.0 2.1 2.2 2.3 . Gross Pathology Manual By The University of Chicago Department of Pathology. Updated 2-14-19 NAC.
  3. Shamim, A; Monira, K; Manowara, B; Sabiha, M; Alim, A; Nurunnabi, ASM (1970). "Weight of the Human Thyroid Gland – A Postmortem Study ". Bangladesh Journal of Medical Science 9 (1): 44–48. doi:10.3329/bjms.v9i1.5230. ISSN 2076-0299. 
    - In turn citing: Langer P. Discussion about the limit between normal thyroid and goiter: mini review. Endocrine regulations. 1999 March; 33(1): 39-45.
  4. Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
  5. . THYROID. Royal College of pathologists of Australia. Retrieved on 2019-12-17.
  6. Kwong, Norra; Medici, Marco; Angell, Trevor E.; Liu, Xiaoyun; Marqusee, Ellen; Cibas, Edmund S.; Krane, Jeffrey F.; Barletta, Justine A.; et al. (2015). "The Influence of Patient Age on Thyroid Nodule Formation, Multinodularity, and Thyroid Cancer Risk ". The Journal of Clinical Endocrinology & Metabolism 100 (12): 4434–4440. doi:10.1210/jc.2015-3100. ISSN 0021-972X. 
  7. Malith, V; Bombil, I; Harran, N; Luvhengo, TE (2018). "Demographic and histological subtypes of Hurthle cell tumours of the thyroid in a South African setting ". South African Journal of Surgery 56 (3): 20–23. doi:10.17159/2078-5151/2018/v56n3a2557. ISSN 00382361. 
  8. Carlé, Allan; Pedersen, Inge Bülow; Knudsen, Nils; Perrild, Hans; Ovesen, Lars; Rasmussen, Lone Banke; Laurberg, Peter (2011). "Epidemiology of subtypes of hyperthyroidism in Denmark: a population-based study ". European Journal of Endocrinology 164 (5): 801–809. doi:10.1530/EJE-10-1155. ISSN 0804-4643. PMID 21357288. 
  9. Swati Satturwar, M.D., F. Zahra Aly, M.D., Ph.D.. Thyroid & parathyroid - Hyperplasia / goiter - Multinodular goiter. PathologyOutlines. Last author update: 11 June 2021. Last staff update: 18 November 2021
  10. Sheren Younes, M.D.. Thyroid & parathyroid Benign thyroid neoplasms. Follicular adenoma.. Pathology Outlines. Last author update: 1 November 2014. Last staff update: 8 March 2022
  11. Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M (2020). "Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers. ". Endocr Pathol 31 (3): 197-217. doi:10.1007/s12022-020-09638-x. PMID 32632840. PMC: 7395918. Archived from the original. . 
    "This article is licensed under a Creative Commons Attribution 4.0 International License"
  12. Shuanzeng (Sam) Wei, M.D., Ph.D.. Thyroid & parathyroid - Other thyroid carcinoma - Main- Oncocytic (Hürthle cell) tumors. Pathology Outlines. Last author update: 1 October 2017. Last staff update: 21 July 2021
  13. Bin Xu, M.D., Ph.D.. Thyroid & parathyroid - Papillary thyroid carcinoma - Papillary thyroid carcinoma overview. Pathology Outlines. Topic Completed: 8 January 2020. Minor changes: 28 May 2021

Image sources